Management of a pregnancy complicated by yolk sac tumor
I Pafilis1, D Haidopoulos, A Rodolakis
11st Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Alexandra Hospital, University of Athens, Athens, Greece. johnpafilis@hotmail.com
Background:
The management of ovarian cancer during pregnancy represents a major challenge and requires close multidisciplinary team approach.
Case:
A 35-year-old pregnant woman with a yolk sac tumor underwent left salpingo-oophorectomy at 25 weeks of gestation. Chemotherapy was deferred to the end of the pregnancy owing to concerns for potential fetal risks. Alpha-feto protein level was used to monitor the underlying disease activity. The patient underwent exploratory laparotomy with cesarean section followed by total hysterectomy, omentectomy, right salpingooophorectomy, pelvic, and para-aortic lymphadenectomies at 32 weeks of gestation. She received four postoperative courses of chemotherapy (cisplatin, etoposide, and peplomycin). Currently, mother and child are doing well 6 months after the last chemotherapy cycle.
Conclusion:
In a case of yolk sac tumor in the second trimester of pregnancy, radical surgery combined with elective caesarian section followed by chemotherapy could achieve remission and rescue of fetus. However, the treatment needs to be individualized as there is lack of evidence.
